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Aviation medicine and the airline passenger
  1. R L Maynard

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    Edited by: Cummin and Nicholson (£65.00) 2002. Edward Arnold Publishers Ltd. ISBN 0 340 80637 0 (hardback)

    Books on aviation medicine and physiology tend to be written by specialists for specialists. This book is by specialists for generalists and will be of value to all doctors asked by patients for health advice prior to flying. It will also be useful, in advance it is hoped, to doctors asked to help with a patient on board a commercial flight. A distinguished group of authors has been assembled: some from the aviation medicine field and some from other relevant specialties including obstetrics, paediatrics, cardiology, and respiratory medicine. Twenty four chapters are provided: each of about 8–10 pages.

    The book begins with an interesting account of the ethical and legal aspects of “Good Samaritan” activity. This is full of sensible advice: the inebriated doctor should disqualify himself from assisting in an emergency! How true. More seriously, the doctor agreeing to act should seek contractual immunity from the captain and if this is refused, the refusal should be recorded in writing. The need to keep clinical notes is obvious but could be forgotten.

    A very valuable chapter on immunisation is provided. This provides much more than a schedule: details of diseases are added. The use of examples: “a 45 year old male teacher is undertaking voluntary work in Russia for 2 years” which is used as a basis for a discussion of diphtheria, is helpful.

    Chamberlain has provided an authoritative account of obstetric and gynaecological incidents. To the non-practising doctor few things are likely to cause greater alarm than an emergency delivery en route. Seeking aid from a midwife is undoubtedly good advice. The value of getting advice from an obstetrician on the ground is stressed: I doubt that I would have thought of that faced with my first delivery since medical school. The advice is practical throughout and easy to follow.

    I looked for a discussion of how to deal with a tension pneumothorax: assuming, probably wrongly, that I could make such a diagnosis in an aeroplane without a stethoscope and faced with an increasingly distressed patient. I was very encouraged by the advice: the inexperienced doctor may well be best advised to do nothing unless he is certain of the diagnosis. If you have to act: cannula, second intercostal space in mid-clavicular line, and a simple valve constructed from the finger of a rubber glove are the things to remember. Pain in the ear is common and well discussed, as is toothache also produced by expansion of pockets of air. In the latter discussion I could not find advice on analgesia: the doctor may be asked to suggest medication and guidance should be provided.

    In conclusion, this is an outstanding book that should be widely read.